The French government announced in the last week of September 2012 that all terminations of pregnancy would be reimbursed in full by the Social Security insurance from 2013. The procedure will therefore be free of cost for women. This was a commitment made by François Hollande during the presidential election campaign in France earlier this year.

Each year in France, there are about 225, 000 abortions and 54% are medical abortions. The cost varies from 200 to 450 Euros, depending on the method and is currently reimbursed by the state at 70% for medical abortions and 80% for surgical abortions.

Restrictions on abortions just don’t work in that they don’t result in the desired outcome. This is the predictable, yet bold, conclusion of a reportto be presented at the United Nations on Monday, October 24th by Anand Grover, a UN-appointed independent expert on health. The report, which is part of an annual report-back from various human rights experts to the United Nations’ General Assembly, consolidates years of legal analysis and empirical evidence from other experts and concludes that abortion restrictions are unworkable and damaging to women’s health. Instead, the report advocates access to full, accurate, and complete sex education and information about contraception, as well as to all forms of modern contraception, because these services and state support for women’s equality actually do work to reduce the need for abortions.

Abortion restrictions are generally justified by reference to a desire to lower the number of terminations, be it by limiting access to abortion for all women, as in Chile, El Salvador, and Nicaragua, or just for the “undeserving,” as in most of the rest of the Americas including the United States. Some explicitly prefer pregnant women to die rather than having access to a life-saving abortion, but most refer to some sort of makeshift hierarchy of morals.

“Most people, of course, should have access free of charge,” a high school friend from Denmark told me the other day. “But women who just keep having abortions: there really should be some sort of punishment for them.”

I have heard this sentiment echoed so many times. “Seriously, I believe in access to abortion,” a young Mexican friend told me. “But really women need to show a minimum of responsibility.” This friend had, in the course of the same conversation, told me he recently had a condom break during intercourse. When asked if he believed the woman in that case, if she were to become pregnant, had shown the requisite minimum of responsibility he was confused and horrified. Of course she should have access to an abortion. At least they had tried.

These considerations about who, if anyone, deserves access to abortion are often at the core of public debate on the issue. All but the most radical anti-choice activists would say that pregnant rape victims should have access, as well as those whose lives or health are threatened by the pregnancy. This distinction between the vulnerable madonnas and the physically healthy sluts is, in fact, the bright line in determining public funding for abortion services in the United States today.

The truth of the matter is that abortion restrictions in law and policy have little if anything to do with how women and girls deal with their pregnancies. Of the hundreds of women I have spoken to about their abortions, none mentioned the law as a deciding factor in whether or not to continue an unwanted or unhealthy pregnancy. Sure, the criminalization of abortion might be an impediment to getting a safe and timely abortion, but never a real barrier to getting one at all.

In fact, the only two questions policy-makers can helpfully ask themselves about their approach to abortion are 1) is it workable; and 2) does it actually work.

Most policies that allow only partial access to abortion for the “deserving” women are not all that workable. You need a process for determining the validity of rape claims, for example, and a solid definition of just how unhealthy a pregnancy needs to be to be unhealthy enough for the woman to be entitled to care. In Ireland, where abortion is only theoretically legal for women who will die as a result of their pregnancy, a doctor asked me in visible distress: “How terminal does she have to be? Can I help her if she has a 51 percent chance of dying, or does it have to be more?”

The notion proposed by my Danish friend—that irresponsible women who just have one abortion after another need to be punished—is equally unworkable. How do you determine responsibility? And how many abortions are too many? And what would be an appropriate punishment? Carrying the pregnancy to term? For many, the key moral question in the abortion debate is whether women who want their pregnancies terminated actually care. But any policy based on a value-judgement on that count raises more ethical questions than it solves. It is not workable.

By Joyce Arthur

October 20, 2011Anti-choice activists in Canada argue that abortion should be defunded and that women should pay out-of-pocket for abortion care. But that is a right-wing ideological position that ignores evidence and human rights. Defunding abortion would be unconstitutional, discriminatory, and harmful to women. The following points explain why. (Each point is expanded upon here with detailed arguments, evidence and citations.)

1. Women’s lives and health are at stake. Funding abortion is necessary to guarantee women’s right to life and security of the person under the Charter of Rights and Freedoms. The main reason the Supreme Court threw out the old abortion law in 1988 was because it arbitrarily increased the risk to women’s health and lives through unnecessary delays and obstructed access. Not funding abortion would have the same effect and the same constitutional problems as the old abortion law, and would put politics and ideology ahead of women’s lives and health.

2. Women’s liberty and conscience rights under the Charter require abortion to be funded. The government must not interfere with the deeply personal decision to bear a child or not, which is integral to women’s autonomy and privacy. Otherwise, the government would be co-opting women’s right to choose by funding childbirth but not abortion, and paternalizing women with an official stance of moral disapproval of abortion.

3. Since only women need abortions, funding abortion is necessary to ensure women’s legal right to be free from discrimination. Restrictive policies and laws that apply to only one gender violate human rights codes that provide protection on the basis of sex. Further, women’s equality rights under the Charter cannot be realized without access to safe, legal, fully funded abortion—otherwise, women would be subordinated to their childbearing role in a way that men are not.

4. Abortion funding is crucial to ensure fairness and equity, without discrimination on the basis of income. We must not compel low-income women and other disadvantaged women to continue an unwanted pregnancy due to lack of funding, or to delay care while they try to raise money. Any delay in abortion care raises the medical risks, especially when it extends into the second trimester. Delays are also a punitive burden that unnecessarily prolong stress and discomfort for women. Best medical practice should ensure that abortion takes place as early as possible in pregnancy, and this requires full funding.

5. Funding abortion is very cost-effective while unwanted pregnancies are costly. The medical costs of childbirth are at least three times higher than the medical costs of abortion, and the social costs of forced motherhood and unwanted children are prohibitive. Further, the overall cost of abortion care to the taxpayer is a pittance relative to healthcare costs as a whole.

6. Funding abortion serves to integrate abortion care into the healthcare system in general, and ensure the comprehensiveness of reproductive healthcare programs, which is essential. If abortions were not funded, it would ghettoize abortion care, as well as the women who need it and the healthcare professionals who deliver it. This would likely increase stigma, lead to other restrictions, further marginalize abortion care over time, and increase anti-choice harassment and violence. All of this occurred in the United States after abortion was defunded for poor women by the 1973 Hyde Amendment.

7. Funding abortion is the right thing to do, despite some peoples’ belief that abortion takes a human life. There is no social consensus on the moral status of the fetus, and our laws do not bestow legal personhood until birth. Regardless, most Canadians believe that the woman’s rights are paramount in all or most circumstances, because she is the one taking on the health risks of pregnancy, bearing a child is a major decision with significant lifelong consequences, and a woman should be able to direct her own life and pursue her own aspirations apart from motherhood.

8. Legal abortion is very safe for women, and generally beneficial. The alleged medical and psychological “dangers” of abortion to women as described by anti-choice activists are either totally false or grossly overstated. Such arguments cannot support the defunding of abortion anyway, since pregnancy and childbirth are actually far more medically risky, and many other funded medical treatments carry substantial risk. Access to legal, safe, fully funded abortion is also beneficial for women and families because it allows them to continue with their lives and plan wanted children later when they are ready to care for them.

9. Opinion polls showing that a majority of voters do not want to pay for abortion are misleading and not pertinent. Voter opinion on this issue has been shaped by anti-choice misinformation, as well as lingering prejudice about women who have abortions. Regardless, voters have no authority to dictate what medical treatments to fund, as this is the role of provinces and medical groups. Women’s basic rights and freedoms must not be subject to a majority vote.

10. Abortion must be funded because it is not an elective procedure, any more than childbirth is. Pregnancy outcomes are inescapable, meaning that a pregnant woman cannot simply cancel the outcome—once she is pregnant, she must decide to either give birth or have an abortion. To protect her health and rights, both outcomes need to be recognized as medically necessary and fully funded, on an equal basis.

11. Anti-choice activists often say that “pregnancy is not a disease” and therefore abortion should not be funded. But the same arguments can be made for childbirth, since there are no medical reasons for a woman to get pregnant and have a baby. More importantly, health is much more than the absence of disease – it’s about achieving a state of overall health and wellness. Women with unwanted pregnancies are not in a healthy place, so their abortion care should be funded.

Why Poland’s Proposed Abortion Ban is a Get-Rich-Quick Scheme for the Medical Establishment and a Death Sentence for Women

July 7, 2011. (Romereports.com) A proposal that would ban all abortions in Poland has been sent by Parliament to committee for consideration. Under current law, abortion is legal if there are serious fetal anomalies or in cases of endangerment to the life or health of the mother. In reality, legal abortion even under these circumstances is inaccessible. There is, however, a huge black market in abortion in Poland and the medical establishment earns nearly $100 million annually off the books providing unsafe abortion.

On June 30th, the Polish Parliament debated a bill that would totally ban abortion in Poland, even if a woman’s life were in danger. The left-wing party put forward a proposal to reject the bill during the first reading but the other political parties demanded the bill be referred to committee for consideration, and their proposal won by a vote of 261 to 155.. The committee will present a report on the bill to Parliament by early September. The draft bill, named “On the protection of human life from the moment of conception” – was initially submitted to Parliament in April 2011. The draft was prepared by the Committee of Legislative Initiative led by Mariusz Dzierzawski, a fanatic opponent of abortion, known as an organizer of the macabre anti-abortion exhibitions held in the Polish cities.

Poland’s abortion law is one of the most restrictive in Europe and even more restrictive in practice than on paper. Although the law allows termination of pregnancy under three conditions – including for therapeutic reasons and when it results from a criminal act – legal abortion is actually not accessible even for women whose conditions fall under the exceptions. According to the annual report on implementation of the current abortion law (“Law on family planning, protection of the human fetus and conditions for legal abortion”) there are approximately 500 (out of ten million women of reproductive age) legal pregnancy terminations a year.

The legal principles are applied with great rigidity and there is widespread abuse of conscience clauses among doctors and entire institutions intended to deny women legal abortion. According to Polish law, physicians can refuse to perform abortion or dispense contraceptives on the grounds of conscientious objection. The conscientious objection clause and the way it is exercised in Poland have become a significant barrier to accessing services to which women are entitled by law. It also happens quite often in Poland that conscientious objection is ”practiced” by the entire hospital, not by individual doctors, which opposes the individuality-based concept of the conscience clause. The recent anti-choice initiative call on the pharmacists to refuse to sell the contraceptives in pharmacies, and was inspired by the Council of Europe’s recent unfortunate resolution “The right to conscientious objection clause in the legal care”.

One case that upset much of the general public concerned a visually-impaired Polish woman, who was denied an abortion on health grounds, even though medical diagnoses confirmed that continuing her pregnancy could further severely damage her vision, thereby constituting a risk to her health.

Meanwhile the criminalization of abortion in Poland has led to the development of a vast illegal private sector with no controls on price, quality of care or accountability. Clandestine abortions generate up to $95 million a year for Polish doctors as women turn to the illegal private sector to terminate pregnancies. Since abortion became illegal in the late 1980s the number of abortions carried out in hospitals has fallen by 99 percent. The private trade in abortions is, however, flourishing, with abortion providers advertising openly in newspapers. The biggest losers are the least privileged: in 2009 the cost of a surgical abortion in Poland was greater than the average monthly income of a Polish citizen. Low-income groups are less able to protest against discrimination due to lack of political influence. Better-off women can pay for abortions generating millions in unregistered, tax-free income for doctors. Some women seek safe, legal abortions abroad in countries such as the UK, the Netherlands, Czech Republic and Germany.

The newest law proposal is being debated by the Parliament, and the report is to be presented in early September. The leftist Democratic Left Alliance Party presented another bill calling for liberalization of abortion. However, the progressive bill will not be discussed by the Parliament during its current term. Parliamentary elections are scheduled for October and it is becoming obvious that abortion will be the main coin used to gain voters. Pro-choice groups are currently forming an initiative to push for a liberal bill introducing refundable legal abortion till the 12th week of pregnancy, funding for contraceptives and sexual education in schools.

Poland is currently presiding over the council of the European Union, and the failure to reject this very restrictive bill on the very first day of the Presidency of the EU Council is a worrying signal to the international community. Polish groups have initiated a campaign calling on supporters to send a letter to the Prime Minister of Poland.

Your Excellency, I write to express my concern that the draft text for the new bill on abortion: “The law on changing the Law on family planning, protection of the human fetus and conditions for legal abortion” – to be discussed by the Parliament’s Committee by the 1st of September – contains provisions on that will result in violations of women’s sexual and reproductive rights and health. The international human rights standard is to liberalize abortion laws to make it safe and accessible to women and thereby lessen maternal mortality related to unsafe abortion. The language used in the draft of the new bill regarding the right to life does not correspond to that used in international and European human rights instruments – to which Poland is also party – as it unconditionally prohibits abortion, thereby leading not to lessening the number of women inducing abortion but only makes it dangerous for women who will undergo clandestine and unsafe abortion. Passing the bill will increase maternal mortality, abortion-related injuries and deaths are likely to be especially high among poor women, who can’t afford to travel abroad. As a result, many of them might try self-induced abortions. It is unacceptable that in the 21st Century, a European country includes in its legislation a provision which directly endangers women’s lives. I trust that you will do your best to ensure that Poland considers reviewing its legislation regarding abortion in a forward-looking legislation, taking the lead in promoting women’s sexual and reproductive rights. Sincerely yours,

It was the “of course” in Dr. Anja Hauge’s (not her real name) e-mail to me that was my first hint that when it comes to abortion, Norway and the United States exist in two different universes.

On a recent visit, I had asked a Norwegian colleague to arrange an interview for me with a physician involved in abortion provision. Dr. Hauge, a prominent gynecologist, agreed to meet with me, and in her introductory e-mail, mentioned that she worked in a large hospital department, where “we, of course, also provide abortions.”

“Of course”?! In the United States, to use “abortion,” “hospital” and “of course” in the same sentence is oxymoronic. Only about 5 percent of all abortions performed in the United States occur in hospitals, and even these relatively few procedures are increasingly under attack. The Republican-led Congress, in one of its first acts after taking control in January, passed the Orwellian-named“Protect Life” Act which stipulates that hospitals receiving federal funds are permitted to refuse abortions to women in life-threatening situations. Just recently, the House passed the so-called Foxx amendment, which would withhold newly available funds for comprehensive medical training from hospitals that provide abortion training.

When I met Dr. Hauge in person, my sense of being on a different planet intensified. To summarize our conversation:

Abortion is “completely integrated” into the Norwegian health care system, paid for (like other medical procedures) by the government, and available virtually everywhere in the country;

ob/gyn residents are expected to undergo training in abortion provision, and though opt-out provisions exist, very few young physicians make use of them;

Abortion, in short, is largely a non-politicized issue, both within Norwegian medical circles, and the population at large.

Comparing the two countries

On paper, interestingly, Norway’s abortion regulations appear to be somewhat stricter than those in the United States. Up through 12 weeks of pregnancy, abortion is routinely available. But between 12 and 18 weeks, a woman must go before a committee before obtaining an abortion, and after 18 weeks, abortions are only permitted in instances of threats to the life or health of the woman and serious or lethal fetal anomalies.

But it is only on paper, of course, that the U.S. situation is more liberal. One of three American women do not live in a county with a provider (several states are now down to one clinic); many women can’t pay for abortion and the majority of states do not permit use of public funding for abortion. (The search for money often pushes poorer women into later abortions, which are more expensive and even harder to find). And, as the recent anniversary of the assassination of George Tiller reminds us, abortion providers are terrorized in this country in a way that leaves Norwegians incredulous—and of course, appalled.

But to my American ears, the most interesting part of our conversation came when we discussed the Norwegian committee system, which deals with requests for abortions after 12 weeks. When these requests are denied by local hospitals, there is an automatic appeal to a central committee. This central committee came into existence a little more than a year ago, because of the authorities’ concern about differing rates of turndowns across the country. Moreover, Dr. Hauge told me, every two years the Ministry of Health convenes a conference to which hospital representatives from all over the country come, to discuss abortion issues.

To be sure, the overwhelming majority of requests for abortions between 12 and 18 weeks are initially approved. Several gynecologists are frustrated with the need for committee approval starting at 12 weeks, and would prefer to see the limit raised to 16 or 18 weeks. As Dr. Hauge put it, “It is humiliating for the woman and a waste of everyone’s time.” But hearing from her that there is a government body that “watches carefully” to assure that abortion policy is being carried out fairly made my head spin.

Norway ranks 1st in State of the World’s Mothers report; United States 31st

So how do Norway and the United States, two countries that legalized abortion at approximately the same time (the former in 1978, the latter in 1973), compare—not only with respect to abortion, but along the whole spectrum of reproductive health outcomes?

Norway, where abortion is freely available, subsidized by the government, and apparently not stigmatized, was recently named by a leading children’s advocacy group as “the world’s best place to be a mother” because of its family-friendly policies and excellent record of both maternal and infant mortality.

The United States, in contrast, notwithstanding the sanctimonious bows to motherhood by anti-abortion politicians, came in 31st—the worst of any developed nation, due mainly to its shameful record of both maternal mortality and under-five mortality.

As I ended my interview with Dr. Hauge, I asked her, as I always do with U.S. physicians, if she wanted her name changed when I wrote about our encounter. She laughed apologetically and said, “It’s better if you change it. I’m not worried about Norwegians, but I don’t want some American (anti-abortionist) reading about me.”

When I returned to my hotel room after our meeting, I opened my computer to find that an arrest had been made in Wisconsin of yet another disturbed individual with plans to murder local abortion providers. Two different planets indeed.

Anti-choice Republicans militating against federal funding of family planning threaten to wreck vital work against HIV infection

Around the world, people are fascinated by the political tussle between Democrats and Republicans over attempts to repeal the landmark US healthcare bill passed last year. Few people realise, however, that if the new Republican-dominated House of Representatives gets its way, it won’t just be Americans who are affected. As part of his repeal effort, House speaker John Boehner is intent on reintroducing the “global gag” rule, a policy that would endanger the lives of millions of women worldwide. America’s culture wars may be coming to a country near you.

The global gag rule, officially known as the Mexico City policy, was introduced by the Reagan administration in 1984, during the United Nation’s International Conference on Population in Mexico City. The policy prevents US overseas assistance from going to organisations that provide information on abortion, perform abortions or direct women to abortion providers.

Because the rule denies funding to organisations that simply counsel women on abortion issues, not just those that perform abortion, family planning Women from developing countries have been let down by the UN, say charitiesfacilities around the world cut back services, close facilities and raise their fees to cover lost income thereby reducing access to their services. These services include contraceptive distribution vital to the prevention of HIV/Aids. When George W Bush restarted the ideological war against family planning by reintroducing the gag rule in 2001, shipments of condoms and contraceptives from USAID was immediately halted to 16 countries. The impact was devastating.

Population Action International, an independent research organisation on family planning, reported that in Kenya five of the most established family planning clinics closed – many of which were the only affordable options in their areas. In Lesotho, where one quarter of women suffer from HIV/Aids, all condom donations from USAID were cut off. With fewer organisations to counsel on safe sex, and with fewer or no contraceptives to distribute, the gag rule actually increases the spread of HIV/Aids in some of the worse affected countries. This, of course, runs directly against official American policy aimed at reducing the number of global HIV infections.

Even more perversely, the policy is self-defeating. Research illustrates that instead of curbing abortions, the number of abortions increased. Countries with family planning services have lower rates of abortion than those without. Because women cannot get access to contraceptives and advice, they end up reliant on the last ditch option when pregnant: abortion. Often, desperate women resort to dangerous non-clinical practices in the absence of professional medical care. The results are horrific and inhumane.

Republicans are quick to accuse those who advocate for a woman’s right to chose of being pro-abortion. The reality is that we are pro-health. Being pro-choice is not equivalent to being pro-abortion. Rather, we understand that this is an issue best left to a woman and her doctor. Abortion is a fact of life, like it or not, and studies have shown that one of the best ways to reduce abortions is to offer preventive family planning, as well as immediate post-abortion family planning and counselling. The figures from one study on immediate post-abortion counselling in Turkey are revealing: the number of clients using contraception after an abortion and subsequent counselling rose from 67% to 91% in one year; and the number of abortions dropped over the decade from 4,100 in 1992 to 1,709 in 1998.

The global gag rule undermines America’s HIV/Aids policy, it risks the lives of countless women and it undermines a core American value – the freedom of speech. Women should have access to a wide variety of family planning and health counselling that should include everything from abstinence to abortion. To argue otherwise, given the evidence at hand, is not just reprehensible; it is immoral.

Is Providing Abortions Creating a “Nuisance”?

The first doctor to try to offer abortion services in Wichita, Kansas, since Dr. George Tiller was gunned down in a church in May 2009 has been blocked from doing so—by her landlord, who has claimed this would create a “nuisance.” And groups opposed to abortion rights are hailing this development as a major win on a prominent frontline in the national war over abortion.

Dr. Mila Means is a family practitioner in Wichita, and since last year she has been preparing to provide abortion services there. (She has been undergoing training with Kansas City abortion provider, Aid for Women.) But on Monday, a state judge issued a temporary restraining order barring Means from performing abortions at her medical office or making any changes to the facility that would allow her to do so. Judge Jeffrey Goering granted this order at the behest of Foliage Development, Inc., the owner of the building that houses Means’ office.

According to a lawsuit Foliage filed on January 28, Means requested permission from her landlord last fall to begin offering abortion services in her office later this year. The landlord turned her down, maintaining that it would violate her lease by “creating a clear nuisance to and disturbing the peaceful possession of all other tenants.” The landlord says that Means indicated that she would proceed with the plan anyway, which he claims would violate the terms of the lease.

The nuisance, however, would stem from protests the landlord anticipates—not from anything that Means would do. Anti-abortion activists from Operation Rescue, which is headquartered in Wichita, have already begun protesting outside her office. An event they held last December at the building attracted about 100 people, including counter-protesters. The landlord’s suit contends that once Means begins to offer abortion services, more protestors, demonstrators, and police will be drawn to the building. The suit notes that the Kansas Coalition for Life has threatened to hold daily protests outside Means’ office and that Operation Rescue has posted Means’ office address and contact information on its website.
According to the landlord’s complaint, the Kansas Coalition for Life has informed the landlord that “it will be a circus out there.” Already, the landlord says, three other businesses in the building have threatened to move because of the possibility of protests.
Wichita has long been an abortion-rights battleground. Operation Rescue relocated its headquarters there in 2002, taking over a building that had once housed Wichita Family Planning, to concentrate on its campaign against Tiller, a prominent provider of abortion services. On May 31, 2009, anti-abortion activist Scott Roeder assassinated Tiller while the doctor was serving as an usher at the Reformation Lutheran Church.

Means would be the first doctor to perform abortions in Wichita since the murder. But before she even could start, Operation Rescue made her a target, posting her photo and address online. “She’s taking the biggest burden,” says Jeff Peterson, the manager at Kansas City’s Aid for Women. His office is getting heat, too. “Local protesters are referring to us a jihadist training camp, saying that we need to be dealt with like jihadists in Iraq and Afghanistan, which is a little bit scary,” says Peterson.
Operation Rescue and its president, Troy Newman, have pledged to use all “peaceful and legal means” to keep Wichita “abortion free.” In a press release hailing the court’s temporary restraining order against Means, Operation Rescue touted the fact that Wichita “has been free from abortions since the closure” of Tiller’s office. Another anti-abortion outfit, Kansans for Life, has been sending out emails warning that a “grave evil threatens our community” and assailing Means for attempting to set up “a killing center” in Wichita.
Peterson says his organization agreed to train Means because of the need for abortion services in Wichita. “We’re doing this for George [Tiller],” Peterson notes. “I’m doing it for the patients. Troy Newman says nobody in Wichita wants this. Then why are people from Wichita coming up here [to Kansas City]? We’ve got a lot of Wichita patients coming here, having to drive three hours because there isn’t a doctor close to them.”
Means’ office declined to comment on the case, citing the ongoing legal process. Foliage Development, Inc. also declined to comment. But Foliage has asked the state court to permanently bar Means from performing abortions at the site. The court has ordered Means to appear at a February 15 hearing.
Kari Ann Rinker, state coordinator for the National Organization of Women and a Wichita resident, says the city had four abortion providers in the 1990s—until anti-abortion activists began waging fierce campaigns against each of them. Eventually, Tiller was the only remaining provider in town. Now the one doctor who wants to fill the vacancy his murder created is being thwarted—not because she’s creating a nuisance but because anti-abortion crusaders are.